Flag on the Play - Football and Health Care Fraud

As part of the NFL’s 2006 collective bargaining agreement, the Gene Upshaw NFL Player Health Reimbursement Account Plan (the “Plan”) was created in order to provide up to $350,000 in tax-free reimbursements for out-of-pocket medical expenses incurred by former players and their families.

To date, 15 retired football players have pleaded guilty in connection with defrauding the Plan. These former players created and submitted false and fraudulent claims to the Plan for medical equipment, such as hyperbaric oxygen chambers and cryotherapy machines, that was never actually purchased. Suspicions arose due to the rather large claims that were being submitted, often ranging between $40,000 and $50,000. This prompted Cigna, the insurance company, to alert federal investigators.

According to a recent press release by the U.S. Department of Justice, Robert McCune, a 2005 fifth-round draft pick and linebacker for Baltimore, Miami and Washington, coordinated the multimillion-dollar health care fraud scheme.  According to prosecutors, several former players solicited other players to participate in the scheme by offering to file false claims in exchange for kickbacks. This led to McCune impersonating Plan participants when making calls to verify the status of the false claims. Fabricated prescriptions and letters of medical necessity were also used as part of the scheme.

McCune and nine other defendants were indicted in December 2019. Since then, however, five other retired players have also been charged for their roles in the scheme, which include conspiracy to commit health care fraud. McCune pleaded guilty to conspiracy to commit wire fraud and heath care fraud, 13 counts of health care fraud, 11 counts of wire fraud and three counts of aggravated identity theft.

On November 19, 2021, McCune faces sentencing of up to 20 years in prison for conspiracy to commit wire fraud and health care fraud, 10 years for each count of health care fraud, 20 years for each count of wire fraud and two years for each count of aggravated identity theft.

Schemes like this are not limited to the health care industry. Billing schemes, where false claims induce the victim company to issue payments for goods or services that are not actually received, happen frequently across various industries. Companies should continuously monitor relationships with vendors and also verify that all vendors are legitimate.

If you have any questions regarding potential fraud schemes, contact Tom Pratt at [email protected] or Brian Webster at [email protected].

This article is part of series highlighting fraud from the professional sporting world in support of  the Association of Certified Fraud Examiner's (ACFE) annual International Fraud Awareness Week. We invite you to read our other articles at the links below.

About International Fraud Awareness Week

ACFE's International Fraud Awareness Week is an opportunity for anti-fraud professionals and communities to come together to look at how far reaching the effects of fraud can be. Check out our Schneider Downs Business Consulting LinkedIn page throughout the week for additional information from the ACFE.

ACFE International Fraud Week Resources

About Schneider Downs Business Consultants

Schneider Downs Business Consultants leverages our experience and industry expertise to maximize value and minimize risk during acquisitions, litigation, arbitration, corporate reorganization and other major business transactions and transitions.

Learn more at www.schneiderdowns.com/business-advisory-services.

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